Introduction:Researchers have emphasized the need to integrate patients into medical education, specifically advocating for patient-based assessments within medical curricula. However, there is a critical gap in understanding how patient involvement is conceptualized and operationalized within assessment practices. Thus, we aimed to gain a deeper understanding of the current discourses surrounding the integration of real patients in the assessment of medical trainees. Methods:We performed a Discourse Analysis using Hodges' empirical discourse methodology. Coding of the 54 included articles initially focused on "conceptualization," "ways patients participate," "opportunities created," "challenges," and detailed aspects of "assessment," including content, development, validation, and format. The team iteratively discussed the codes and themes until they reached a consensus about the data interpretation. Results:We identified three distinct-yet not always mutually exclusive-discourses: (1) patients as survey-fillers, (2) patients as feedback providers, and (3) patients as part of programmatic assessment. Discussion:By illuminating these discourses, this study deepens our understanding of why patient involvement takes the forms it does and suggests that moving toward positioning patients as part of programmatic assessment may offer a more meaningful basis for patient partnership in the assessment of medical trainees.

Introduction: Medical educators agree on the importance of teaching clinical reasoning (CR) at the undergraduate level with a deliberate curricular approach. Despite recent recommendations on how to reach this objective, there are limited empirical data on how it unfolds once implemented. This study advanced the understanding of how a deliberately designed CR curriculum was experienced and contributed to students’ CR development. Our study sought to add to the conversation on undergraduate CR curricula by providing data that could be relevant and applicable across other learning contexts. Methods: We conducted a qualitative descriptive study in the context of a competency-based medical program that is interdisciplinary, with spiral integration. Through nine focus groups, we sought the experience of curriculum designers, teachers, and students on how the CR curriculum embedded into the program contributes to students’ CR development. Data were analyzed using a thematic approach. Results: We identified four overarching themes: 1- Global coherence of the curriculum around the development of CR; 2- Interdisciplinary integration to enhance CR development; 3-Cognitive load of students and pervasive time constraints; 4- Active teaching methods that promote the development of CR. Discussion: From the different stakeholders’ perspectives, students acquired various knowledge types in CR domains and applied them to problem-solving. Stakeholders’ experiences with the implemented CR curriculum matched the initial intent but presented some challenges as well. These findings underscored both the feasibility and the complexity of embedding CR within an undergraduate medical curriculum. Careful attention is required to support students and teachers.

The World Health Organization (WHO) defined 'social accountability for medical schools' in 1995; yet 30 years later, many remain concerned that medical schools are not living up to societal expectations. In this article, we first place the WHO's definition into historical context, then we contrast the WHO social 'contract', where schools are expected to demonstrate value for money, with the more altruistic 'code' that had been put forward previously by Abraham Flexner. We discuss contemporary barriers to advancing social accountability, including tacit assumptions about the semantics of the term accountability, the geographic communities schools should serve, how schools are financed, and expectations for school outcomes. We suggest that the future of social accountability for medical schools movesbeyond social codes and contracts to recognizing the varied ways that medical schools contribute to diverse individuals and groups within communities along a local to global spectrum. While it is unlikely that there will be universal consensus on what makes a medical school valuable to those whom it impacts, medical schools should make data available that allow others to render their own judgments and participate in conversations that help medical schools and medical education systems better align resources with needs.

INTRODUCTION:Addressing the social determinants of health (SDOH) can improve cancer-related outcomes and is widely recognized as integral to patient care. Despite this, little is known about how medical oncology residents perceive their role in addressing SDOH. Understanding their views is important not only because SDOH impact outcomes, but also because residency training should prepare oncologists to respond to evolving societal needs. In this study, we use Figured World (FW) theory to explore how residents negotiate their role within the sociocultural world of medical oncology training. METHODS:We conducted semi-structured interviews with 11 medical oncology residents from the four faculties of medicine in Québec, Canada. Participants were recruited through program directors, newsletters, and snowball sampling. Interviews were audio- and video-recorded, transcribed verbatim, and thematically analyzed. FW theory helped orient our analysis toward how residents make meaning of their roles and responsibilities, how they perceive societal expectations, and how they see themselves within the context of medical oncology training. RESULTS:We identified four key themes: (a) becoming an oncologist: what does it mean and entail?, (b) dealing with SDOH in medical oncology: a distressing role, (c) exploring the roots of powerlessness when confronted with SDOH, and (d) negotiating their roles and positioning themselves relative to others in addressing SDOH. DISCUSSION:Residents expressed a desire to engage with SDOH but felt largely unprepared to do so, pointing to gaps in training and support. These findings call for a rethinking of how oncology residency training shapes professional identity, ensuring that future oncologists are prepared to take on roles that encompass both clinical care and social accountability.

CONTEXT:Research in health professions education (HPE) is increasingly produced by collaborative teams that transcend disciplinary, institutional and professional boundaries. Yet, despite the centrality of these teams to the field's scholarly output, we know little about the social and structural dynamics that enable research teams to function well. In this Cross-Cutting Edge paper, we argue that the concept of cohesion-well established in sport psychology as a determinant of team performance-offers a productive and underexplored lens for understanding HPE research teams. Cohesion captures both the task-related alignment that enables members to pursue shared scholarly goals and the social bonds that support communication, conflict navigation and sustained collaboration. DISCUSSION:Drawing on Carron's multidimensional model of team cohesion, we adapt four determinants of cohesion to the context of HPE research, including environmental, personal, leadership and team-level factors. We propose that these factors provide a conceptual scaffold for examining how research teams develop, function and sustain collaborative work over time. To support this argument, we integrate insights from sport psychology, team science and recent scholarship describing the nature of HPE research teams. Positioning cohesion as a conceptual lens opens new avenues for empirical inquiry into the life cycle of research teams, the conditions under which they thrive and the practices that support their development. CONCLUSION:Greater attention to cohesion may strengthen research capacity, enhance team functioning and support high-quality collaborative inquiry in HPE.

Most health professions education programs are transitioning toward outcomes-based education, emphasizing measurable competencies and programmatic assessment. However, these models—largely focused on teaching and assessment strategies—often overlook the institutional, political, and relational dimensions that shape how curricula are conceived, approved, and enacted. This study examines curriculum as both an educational product and a governance artifact, drawing on the case of a newly established French-language Doctor of Pharmacy (PharmD) program in Canada. We conducted a qualitative case study informed by a critical realist approach, using curriculum-making theory and institutional entrepreneurship as sensitizing frameworks. Data collection unfolded in three phases to deepen understanding of governance mechanisms. First, a review of foundational documents was used to construct a chronological account of program development. Second, exploratory interviews with stakeholders refined this timeline and informed an initial program theory. Third, in-depth interviews with 14 stakeholders—including administrators, academic leaders, financial officers, analysts, and external funders—examined governance dynamics across institutional levels. Analysis identified eight governance mechanisms operating across three overlapping phases: vision development, approval, and implementation. Mechanisms such as coalition-building, navigating governance structures, and mobilizing resources operated across micro, meso, macro, and supra levels, highlighting governance as distributed and adaptive. We argue that curriculum is not merely a pedagogical blueprint but an institutional project forged through multi-level negotiation and strategic agency. Integrating governance into the conceptualization of curriculum highlights its role in shaping institutional identity and invites educators and leaders to approach curriculum development as both a pedagogical and political process.

Innovative qualitative approaches are essential for exploring how health professions education (HPE) can address complex, value-laden constructs such as social accountability. Visual elicitation techniques, including rich picture interviews (RPIs), offer distinctive opportunities to surface layered, affective, and contextually embedded understandings. This methodological study examines participant perspectives on the use of RPIs within a broader qualitative interpretive description on social accountability. 46 participants, including learners, community representatives, faculty, and institutional leaders, created rich pictures (20–30 min) followed by semi-structured interviews (60 min) conducted virtually in English or French. Importantly, a dedicated segment of each interview explicitly elicited participants’ reflections on the RPI process itself, including its accessibility, relevance, and perceived value. Data were analyzed using Braun and Clarke’s reflexive thematic analysis. Three overarching themes captured participants’ experiences: (a) from hesitation to reflective engagement, (b) visual thinking as a catalyst for dialogue and adaptability, and (c) affordances and boundaries of RPIs. Many began with apprehension, often tied to artistic skill or ambiguity of the task, yet valued RPIs for structuring reflection, deepening emotional engagement, and anchoring abstract concepts in personalized, tangible representations. Participants noted the method’s adaptability across cultural, linguistic, and professional contexts, while also identifying barriers such as discomfort with drawing or the abstract nature of social accountability. By documenting these experiences across diverse partner groups, this study offers practical guidance for employing RPIs in HPE and related fields. RPIs can serve not only as data collection tools but as reflective, generative spaces that bridge abstract ideals with concrete experiences.

Health systems worldwide continue to face health inequities rooted in social, political, and economic structures. In response, health professions education (HPE) programs are increasingly aiming to prepare learners for socially accountable practice. Despite this growing attention, social accountability remains ambiguously defined and inconsistently taught, assessed, and enacted across curricula. The aim of this scoping review was to map the breadth and depth of educational approaches within HPE that promote social accountability. A scoping review was conducted following Arksey and O’Malley’s six-stage framework and the Joanna Briggs Institute methodology. MEDLINE, EMBASE, CINAHL, ERIC, APA PsycINFO, and Education Source were searched for articles published from January 2000 to May 2020, with an updated search in 2024. Screening involved a calibration exercise at both title/abstract and full-text stages. Descriptive numerical analysis and reflexive thematic analysis were employed, supported by knowledge user consultation. Most articles originated in North America (n = 179; 82

Background: Medical schools play a critical role in shaping the physician workforce. Tracking the practice locations of medical graduates is essential for addressing healthcare disparities and workforce shortages in underserved regions. This study examines the geographic distribution of residency graduates from a Canadian francophone university, aligning their practice locations with the university’s social accountability mandate. Methods: A cross-sectional descriptive study was conducted using data from the Canadian Post-M.D. Education Registry (CAPER) for 2,410 residency graduates (2000-2020) from 35 residency training programs. We analyzed practice locations at two-, five-, and 10-years post-graduation across medical specialties, sex, and geographic region, with a focus on Quebec’s administrative health regions. Results: There were 2,410 graduates from 35 residency training programs. Family medicine accounted for 57.8% of all graduates and 42.2% were from all other specialties. Most graduates (77.7%) practiced in the province of Quebec, with concentrations in the regions of the Eastern Townships (19.4%), Montérégie (14.6%), and Saguenay-Lac-St-Jean (7.6%). Conclusion: This study demonstrates the important regional impact of the university’s role in training family physicians and addressing healthcare needs in Quebec. The findings suggest the importance of tracking to inform evidence-based workforce planning and policy development. Medical schools can leverage such data to align training programs with societal health needs and enhance their contributions to regional healthcare systems.

Background:Social accountability (SA) occupies an important place in the accreditation requirements of Faculties of Medicine. We analyzed the evolution of SA in the undergraduate medical program at the University of Sherbrooke since the implementation of a complete curriculum in two distributed medical campuses. Methods:Using a qualitative and sequential research design anchored in Boelen's conceptual framework, we conducted a document analysis of strategic plans and accreditation documents between the years 2006-2023 to identify the SA actions of the medical program and generate an initial narrative with a timeline. Following three interviews and three focus groups with key actors at each campus, we developed a final portrayal of SA with a timeline. Results:The portrayal describes the way in which the faculty and its medical program planned their commitment in line with the identified health needs of the population (conceptualization), implemented actions to meet these needs (production) and verified that these actions "have had the greatest possible impact on people's health" (usability). This approach demonstrates the time required to observe an increase in actions related to usability. Conclusions:This study made it possible to identify the work accomplished since 2005 by highlighting the strengths and challenges. This understanding of the road traveled, and the challenges encountered, will be shared with partners to identify further actions in response to the health needs of communities served. This approach and the resulting findings may serve as a source of information for other faculties of medicine interested in undertaking an analysis of their social accountability actions.

Conducting research is a deeply relational human endeavour – from the shared joy of engaging in an exciting project with a trusted research team to the complexities of navigating conflicting research priorities with a new collaborator. In this article, we explore seven different types of research relationships – from archenemy to academic bestie – and describe the advantages, disadvantages and forms of recognition befitting each of these relationships. Through this whimsical examination of the social aspects of engaging in research, we acknowledge the importance of human relationships that can motivate, support, impede, or undermine research work.

BACKGROUND:Medical students' career intentions and choices are shaped early in their education, at a time when their interaction with various specialties and professional influences is both formative and essential. Despite this being a pivotal period, the literature offers limited insights into what drives students' specialty choices during these early stages. Our study seeks to address this gap by exploring how medical trainees engage in sensemaking around specialty choice, navigating the interplay between individual aspirations, institutional contexts and perceived professional expectations. METHODS:We conducted an interpretive descriptive study with two consecutive student cohorts at a francophone university in Canada during the implementation of a new medical campus site. Using purposive convenience and snowball sampling, we held 10 focus groups (in-person and virtual): six with first- and second-year medical students and four with clinical teachers. Inductive thematic analysis was employed to interpret the data, enabling us to identify key patterns and relationships between participant perspectives. RESULTS:The participants' perspectives organised around five key themes including (a) navigating career indecision and decision-making processes, (b) role of lifestyle, work-life balance, and career sustainability, (c) role of early educational experiences in career selection, (d) influence of mentorship and role models on career orientation, and (e) hidden curriculum and perceptions of specialty prestige. CONCLUSION:This study offers insights into the factors influencing medical students' specialty choices early in their training. By identifying actionable elements within the undergraduate medical curriculum and the broader learning environment, training programmes can better support students in making well-informed career decisions.

BACKGROUND:Health professions education curricula are undergoing reform towards social accountability (SA), defined as an academic institution's obligation to orient its education, service and research to respond to societal needs. However, little is known about how or which educational experiences transform learners and the processes behind such action. For example, those responsible for the development and implementation of undergraduate medical education (UGME) programs can benefit from a deeper understanding of educational approaches that foster the development of competencies related to SA. The purpose of this paper was to learn from the perspectives of the various partners involved in a program's delivery about what curricular aspects related to SA are expressed in a UGME program. METHODS:We undertook a qualitative descriptive study at a francophone Canadian university. Through purposive convenience and snowball sampling, we conducted 16 focus groups (virtual) with the following partners: (a) third- and fourth-year medical students, (b) medical teachers, (c) program administrators (e.g., program leadership), (d) community members (e.g., community organisations) and (e) patient partners. We used inductive thematic analysis to interpret the data. RESULTS:The participants' perspectives organised around four key themes including (a) the definition of a future socially accountable physician, (b) socially accountable educational activities and experiences, (c) characteristics of a socially accountable MD program and (d) suggestions for curriculum improvement and implementation. CONCLUSIONS:We extend scholarship about curricular activities related to SA from the perspectives of those involved in teaching and learning. We highlight the relevance of experiential learning, engagement with community members and patient partners and collaborative approaches to curriculum development. Our study provides a snapshot of what are the sequential pathways in fostering SA among medical students and therefore addresses a gap between knowledge and practice regarding what contributes to the implementation of educational approaches related to SA. We emphasise the need for educational innovation and research to develop and align assessment methods with teaching and learning related to SA.

Research teams are an important means by which knowledge is generated in Health Professions Education (HPE). Although funding agencies encourage the formation of interdisciplinary and interprofessional research teams, we know little about how our interdisciplinary and interprofessional research teams are functioning, nor how best to ensure their success. Indeed, while HPE Scholarship Units and research environments have been the object of study, little work has been focused on research teams themselves. In this article, the authors propose that research teams should be studied as unique instantiations of teams where several individuals work together towards a common goal. Considering research teams as a team can encourage attention to how effective teams are built, supported, and celebrated, it can acknowledge that competent individuals may form incompetent teams, and it opens important avenues for future research. Turning our attention to better understanding how and when research teams thrive should support the development of more effective teams; resulting in reduced waste and redundancy, better mobilization of team members’ time and skills, and enhanced knowledge generation. Considering research teams as teams, encourages an understanding that these teams require care, commitment, and effort to sustain them, and it acknowledges that pursuing research in a team context is both a collaborative and a social endeavour.

Background and Need for Innovation:Teaching and learning approaches can support medical students in developing the research skills necessary to be adept consumers of scientific research. Despite various influencing factors, existing literature on effective strategies in undergraduate medical education remains limited. Goal of Innovation:Using a spiraled curriculum, we created and evaluated a longitudinal course to enhance medical students' research abilities. Steps Taken for Development and Implementation of Innovation:During a recent curriculum renewal at one medical school, a three-year longitudinal course on the principles of research was developed and implemented. The innovation of this course includes the sequential nature and deliberate redundancy of curriculum content, how new knowledge is linked to prior learning, and the progressive level of difficulty in knowledge application and skill development. Evaluation of Innovation:The authors analysed faculty members' and students' satisfaction and their perceptions of each session of the course using program evaluation data collected between 2019 and 2021. Both faculty members and students recognized the benefits of revisiting concepts and highlighted learning outcomes like improved synthesis of information, explaining findings to patients, and enhanced critical thinking. Critical Reflection:The adoption of a spiraled curriculum in undergraduate medical education offers a systematic approach for developing students' research skills. The positive reception of this innovation underscores its potential to help future health professionals form a professional identity as adept researchers. However, its implications demand careful consideration and ongoing evaluation to ensure that the desired outcomes are sustained.

Transformations in health professions education are presented as a lever to achieve meaningful societal change and generate reforms that are more authentically aligned with evolving health needs.